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HomeMy WebLinkAbout2026-00052983 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 I0110 II I flfl IIII II flllI 0 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X76472' u, 1 U21 2 4 1 U, 2 U2 1 U, 1 u2 1 U, 1 U2 1 1 10 U1 3 U2 1 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT ® q No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW ' Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 1 VEHICLE/PROPERTY ®OVER 51,500 ❑NOT ON SCENE(DESK REPORT) El AMENDED ❑ B Injury and for Tow Due To Crash YR 202612026-00052983 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n ® ❑ RELATED 0 Y ®N 09 01 2026 ®AM ❑YES ®NO U1 N MCLEAN BLVD Elgin07:03 g PRIVATE mo /day/yr ❑PM FLOW CONDITION m FT/MI N E S W ILLINOIS PKWY COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 1 cn ❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD ❑ STOPPED U2 —I El AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 RED 0 PEDAL 0 EWES 0 NUV 0 ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) 4 n Y N 0 3 / yr TORREZ ORTIZ. MANUEL Mazda 3 2024 00-NONE ©, 12 , DUE TOCRASH ❑ 13-UNDER CARRIAGE 10.I !�. 2 FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 4 rn M 2 4 ❑Y ®SNEM El LINK VEH. 0 AT CRASH IN ENGAGE0 99-UUNKNOWN 9 16-TOP 3 ,Distraction Value 9 ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6 it 6 ii,4 COM VEH 0 j$J 1 0 ELGIN N I L 60120 0 1 0 FIRST CONTACT 11 7_;1 __-S *II Yes.See Sidebar U1 Z EE26719 IL 2026 REAR TELEPHONE IL D 0 JM1 BPBLMXR1652047 STATE FARM ❑Y ®N U2 m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Same 0811380-SFP-13 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER > Refused ❑Y ❑ N 2 0 N DRIVER ❑ PARKED 0 DRIVERLESS 0 FED 0 PEDAL 0 EWES 0 New 0 Nev 0 DV !1 9$4 Honda CRV 2024 00-NONE 11_. t2 FROM TOWED DUE TO CRASH ❑ C 2 73 0 13-UNDER CARRIAGE I 2- FIRE ❑ El U2 C : F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 016•TOP 3 X ❑Y ON DUNK VEH. AT CRASH 99-UNKNOWN *0istraellon Value 9 0 POINT OF s I I 4 COM VEH D ® Ut W N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR FIRST CONTACT 10 Y � B 1 .-5 C. If Yes.See Sidebar C ~ CARPENTERSVILLE IL 60110 0 1 0 G312444 IL 2026 R' 0 Si) IL D 0 7FARS6H87RE066644 STATE FARM ❑y ®N RDEF 73 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER 1 X 99 9 Same 3124491-SFP-13 BAG $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused 0 Y°ND 0 N U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)1(ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL) 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z co N 1 CD 11 1 09/01 /2026 07 04 ®❑PM in a Work Zone? ®N DIRP D 1 1 PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ❑AM If YES check one below: U1 o", T 2 n 2 ❑ 2 28 1 / ❑PM, ❑Construction * R 3 ❑ $ 5 I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME ❑AM ❑Maintenance U2 -a, ARREST NAME TORREZ ORTIZ. MANUEL 11-601-Ax S1541000920 / / El PM SLMT oN ® 11 1 0 CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ❑Utility 1 2 ❑ ARREST NAME AM c- T 1 / PM ❑Unknown work zone type 30 U1 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑AM Workers present? ❑Y 30 1541-Wilkerson.Tondeo 602 320-Cox 10 ,20/2026 01 30 ®PM ®N U2 REMEMBER TO USE BLACK INK,PRESS HARD,PRINT LEGIBLY AND COMPLETE ALL REQUIRED FIELDS! A Diagram and Narrative are required on all Type B crashes, LARGE TRUCK, BUS, OR HM VEHICLE even if units have been moved prior to officer's arrival. IF MORE THAN ONE CMV IS INVOLVED,USE SR 1050A ADDITIONAL UNITS FORMS. r ----r••--, , ; A CMV is defined as any motor vehicle used to transport passengers or property and: Z 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< } }-- -'-- --' i N - INDICATE NORTH combination):or -I el L____4,17BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C _ r (example:shuttle or charter bus):or 3. Is desgned to carry15 or fewer passengers and operated a contract carrier O Not To Scale I } } } transporting employee In the course of their employment(example:employee X I transporter-usually a van type vehicle or passenger car):or w L L.__-a__ i I. } I. •4. Is used or designated to transport between 9 and 15 passengers,including the driver. C J L. for direct compensation(example:large van used for specific purpose):or O L L-__-a-___. + - i 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires r 'D ro m UNIT r placarding(example:placards will be displayed on the vehicle). ;p �,:: .. r r CARRIER NAME Z —�` I ADDRESS l `�) I CITY/STATE/ZIP 0 g _ i. i. i. i. 4. MOTOR CARR.ID 0 Interstate ❑ Intrastate 5 0 I I . I ❑ Not in Comm./Govt. 0 Not in Comm./Other r r "T""1 USDOT NO. ILCC NO. m XI Source of above z . own tank)? 0 Yes 0 No 0 Unknown —I D Did HAZMAT Regulations violation contribute to the crash? r ❑ Yes 0 No 0 Unknown g D Did Carrier Safety Regulations MCS)violation contribute to the crash? A ❑ Yes II El Unknown C Was a driver/vehicle Examination Report Form completed? r HAZMAT ❑Yes 0 No ❑Unknown Out of Service ❑Yes ❑No 7 MCS ❑Yes 0 No 0 Unknown Out of Service ❑Yes ❑No C Z Form Number 0 m Xl IDOT PERMIT NO. WIDELOAD'; ❑Yes 0 No 2 TRAILER VIN 1 m to LOCAL USE ONLY TRAILER VIN 2 m 0 TRAILER WIDTH(S) 0-96" 97-102" >102' -n TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 0 o u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w Gray Blue u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT 2 TOWED BY/TO: _ SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO. DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE